40ish would-be parents discover hope, help in new fertility clinic

News-Times, The (Danbury, CT)

Published 7:00 pm, Saturday, March 5, 2005

"We're still human beings, the same human beings who have been on this world for the past two million years,'' said Dr. Mark Leondires.
Which means certain biological imperatives rules our lives. One is that a women over 35 years old will have a lot more trouble conceiving a child than a woman of 20. Another is that men who are not producing a lot of viable sperm may have trouble getting their wives pregnant.
Leondires and his partner, Dr. Spencer Richlin, spend their days trying to help couples have babies. They are fertility experts - board-certified reproductive endocrinologists - who run Reproductive Medicine Associates of Connecticut in Norwalk, the only free-standing fertility clinic in Fairfield County.
But because Danbury area couples don't warm to the thought of frequent bumper-to-bumper trips down Route 7, the two have brought their expertise north.
Richlin and Leondires have opened a satellite office at the Women's Health Center at Danbury Hospital. They do lengthy initial consultations, ultrasounds and blood work at the hospital, reserving the trips to Norwalk for more complicated procedures. Leondires said that, without much fanfare, their hours at Danbury Hospital are quickly filling up.
"This work requires a lot of commitment from the women. It means getting ultrasounds and blood work every other day for one to two weeks to start,'' Leondires said. "It's a lot to do. Coming down Route 7 to our office in Norwalk only adds to the stress.''
And stress, the two agreed, is often one of the elements that prevent couples from conceiving.
"It can be a stressful time in a couple's life,'' Richlin said. "We like to explain their options concisely and discuss the best ways we can get them pregnant. In some ways, we de-stress them by leading them through the process. But we also always advise them to start an exercise program, do yoga, get acupuncture, or go to group counseling to reduce the stress in their lives as well.''
But there are other factors in the equation. A chief one is that many woman aren't getting married at 18 and pregnant at 20 anymore. They're going to college and graduate school, and establishing careers. Then, in their mid-30s, their perspectives on life change and they want to get pregnant.
The problem is that women's ovaries have a finite number of eggs to produce. After 35, that production slows down. Women come to the clinic, Leondires said, only to learn how hard it will be for them to get pregnant.
Leondires said most women are infertile by the time they reach 43. "So if you're in that age group and you want to get pregnant, you have to actively work on a plan.''
Leondires and Richlin work closely with their patients to learn about their cycles and hormone levels. When that work is complete, they may prescribe oral medications that increase a woman's fertility.
"Normally, a woman produces one egg a month.'' he said. "With these drugs, they can produce two to six eggs a month.''
By combining those drugs with artificial insemination, Leondires said, and by carefully monitoring the patients, Reproductive Medicine Associates has greatly reduced the number of multiple births that couples fear. In the three years the clinic's been open, Leondires said, patients have only rarely had triplets, and none have had quadruplets or quintuplets.
If oral medication fails, the clinic can offer patients injected fertility drugs. But Leondires said, because these drugs often cause women to produce six to eight eggs a month, it's much harder to control multiple births.
Instead, he said, he and Richlin usually recommend women undergo in vitro fertilization. With this process, the clinic's staff removes a woman's eggs, fertilize them in their husband's sperm in a petri dish, then implants the fertilized eggs in a woman's uterus. The clinic is completely equipped to do all this work on its premises.
"This is still a new field - it's only 25 years old,'' Leondires said. "But the rates of take-home pregnancies from it have gone from 20 percent to 40 or 50 percent. We have better medications, better lab procedures and the doctors know how to do it better. It gives us the highest pregnancy rate with the lowest rate of multiple births.''
What's often overlooked in couples having problems conceiving, isn't eggs but sperm. For about a third of the couples that come to Reproductive Medicine Associates, the problems with conceiving come from the male.
Low sperm count can be caused by several factors, including varicocele - a collection of veins in the scrotum that can lower sperm count but that can be repaired by micro-surgery.
Richlin said that for a man with low sperm count the clinic can inject a sperm directly into an egg to fertilize it.
"That's very successful,'' he said.
Men can father children late in life. But for women - even those getting help - age still limits success. Leondires said that for a woman under 35, in vitro fertilization has a 50 to 60 percent success rate. For women over 40, that goes down to 20 percent.
Richlin said many couples who don't succeed at getting pregnant return for a second round of treatments. When that happens, he said, the clinic will re-study the couple's problems, trying to improve on any details of the treatment.
But sometimes, he said, the clinic simply has to tell a woman that, given her age, and her eggs, the chance of pregnancy is too low, and the cost of the treatment - about $12,000 - too high to continue.
At that point, there is another option. Reproductive Medicine Associates can offer women donor eggs - eggs that young women have sold to the clinic. These women are carefully screened before they're accepted into the program; if they are accepted, the clinic pays them $8,000 for their eggs.
"We only accept one out of 10 women that come to us as donors,'' Richlin said.
Donor eggs become the couple's property. The husband's sperm can be used to fertilize the eggs, which are implanted in the wife. While women stop producing eggs in their early 40s, Richlin said, "the uterus is very understanding,'' and women in their 40s can easily carry a child full term with simple hormone injections.
"Some women really want to experience pregnancy, to bond with their infant that way,'' Richlin said. "It's not an issue of genetics for them.''
The clinic also works with women who have suffered recurrent miscarriages. And finally, he said, the clinic offers couples referrals and help adopting a child, if they decide that's the route they wish to take.
Not every couple that wants the clinic's services can afford them. Leondires said many health insurance companies regard reproductive medicine as akin to plastic surgery, and won't pay for it.
"The desire to have a family is not the same as the desire to have a flat belly,'' Leondires said.
And because couples bring such deep emotions to the clinic, working with them becomes an emotional journey for Leondires, Richlin and their staff.
"The women can be depressed because they want to be pregnant and they aren't,'' Leondires said. "With guys, if their sperm count is low, they're depressed because they want to have a baby and there's this feeling that they're not a real man. These things can really bring a couple together or drive them apart.''
So when the clinic has a run of successes, everyone who works there is smiling. When it goes a few days without a pregnancy, that high dissipates. Throughout the process, Leondires and Richlin said, they have to show the same care and concern to every patient, every couple.
"The nicest thank-you notes we get are from patients who don't get pregnant, but appreciate what we did anyway,'' Leondires said.

For more information about the work of Reproductive Medicine Associates of Connecticut, go to its Web site at www.thecenter-norwalk.com; call the clinic at (800) 865-5431; or call the Women's Health Center at Danbury Hospital at (203) 797-7186.